Provider Demographics
NPI:1043833700
Name:VALDEZ ESPINOZA, MARCO ANTONIO (MD)
Entity type:Individual
Prefix:MR
First Name:MARCO
Middle Name:ANTONIO
Last Name:VALDEZ ESPINOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:MARCO
Other - Middle Name:ANTONIO
Other - Last Name:VALDEZ ESPINOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3131 N MAIN ST APT A101
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2627
Mailing Address - Country:US
Mailing Address - Phone:312-792-6892
Mailing Address - Fax:
Practice Address - Street 1:1003 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1641
Practice Address - Country:US
Practice Address - Phone:920-771-5470
Practice Address - Fax:602-406-5430
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2024-09-10
Deactivation Date:2022-02-10
Deactivation Code:
Reactivation Date:2022-03-16
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ71876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program